Russ Ford's Blog

Obama Care and Canada's Health Care Debate

Most of the world has watched what has gone on in Washington with complete bewilderment. Elected officials, people voted into office to run the government, actually closed it down.

We let our governments pirogue the commons/legislature. Governments here do that to save their political lives. When it happens the functions of government continue. Government offices remain open and with the possible exception of the CBC few notice that parliament is not in session. South of the border, closing government means a real closing of government services and that affects the lives of millions of people.

That is not the only difference. The American debate can centre on what the "founding fathers" would say. They were a group of slave owning men who roamed the eastern sea board about 250 years ago. For some reason, their opinions still matter.

So let me do the same. What would our "Fathers of Confederation`` say about the Scarborough subway for example. If Charles Tupper was with us now, I know he would oppose it. He supported the creation of an above ground steam powered railroad, therefore logically he would oppose an underground electric system. (Of course he would not have the smallest idea what electricity is)

Yes, that makes no sense but it makes about as much sense as saying Jefferson or Adams would oppose Obama Care therefore all freedom loving Americans must do so as well.

While much of the American political angst seems to centre around the idea of public health care, this is the 50th anniversary of our national Medicare program which arguably is the most significant piece of legislation in this country's history.

There are ways we are defined by our age. Moments in history that we were either present for or not. I remember the Leafs winning the Stanley Cup which clearly dates me. I also remember life before Medicare although I have very few recollections of the pre Medicare health care system.

The reason why I do not remember much about our health care system pre 1963, has nothing to do with the number of hits I took to the head playing sports. It is not a memory issue. The real reason is because we rarely, if ever, accessed the health care system when I was a child.

We could not afford to go to the doctor so visits were confined to only the most serious of maladies. My mother`s solution to most injuries or illnesses was to give you a cup of strongly brewed tea. My mother was from England, a country that created universal health care in 1919 and there were times when she would say that she could not understand how a country as rich as Canada did not take better care of its citizens.

The 1960s changed a lot of things. Medicare came in over the howls of the medical profession but that was not the only change. Equally important was a change of attitude and focus. The consumer movement , which was largely spearheaded by the work of Ralph Nader in the auto industry, also came to health care.

Public debate on health now went beyond a discussion solely between doctors and politicians. While a discussion of the relationship between the determinants of health was a few years away, we were now at least talking about lifestyle choices like smoking and exercise. More importantly people were talking about taking control over their own health.

It could be argued that the birth of Community Health Centres like LAMP was an outgrowth of the rise in consumerism in health care, but it was also an economic decision. Premier Robarts concerned about rising health costs and no appreciable change in the health status of the population commissioned Dr. John Hastings who was then the Dean of Medicine at the University of Toronto, to figure out what needed to be done to increase health stratus and reduce costs.

Dr. Hastings wrote a report which called on the government to invest in a new model of service delivery which he called the “Community Health Centre” model. As expected there was much opposition to Hastings’ report which centered on the notion that doctors should be paid a salary. If Medicare was not enough, doctors on salary were clearly an indication that we were travelling down the road to socialism.

The government bought the Hastings report and quickly funded a number of pilot projects for one year. That is why the “P” in LAMP stands for ``project.`` It was just to last one year. What the government thought it was buying and what it actually got were of course two different things. CHCs did not bring the health care budget under control. There were not enough of us to make a significant budgetary difference. The early CHCs were very poorly funded. Staff and board members at LAMP furnished the building by picking up things at garage sales and the first doctors were paid at the level of a missionary.

Early CHCs were on the extreme fringe of the health care system. In fact it would not be a stretch to say that no one including ourselves really saw us as part of the “system”. It was a context however that provided the ethos for a movement. We were not part of the system because we did not want to be part of something that we regarded as not client centered to use a more modern day term. We openly talked about the CHC movement and there was no need to explain it any further. We just knew what it meant.

First and foremost, it meant community control. The boards of the first CHCs were very much a part of the management of the centres. But more than that they brought a community focus to the work of the centres. No two CHCs were the same because no two communities were the same. There was minimal contact between the centres.

Many of the early boards were populated by individuals who did not believe the health care system such as it was, should be the sole domain of physicians. They also knew from their own life experiences that health was not just about the absence of disease, it was much broader and an individual’s health status was often determined by social factors such as poverty and level of education. CHCs were community based organizations steeped in the ideals of social justice.

The early CHCs organized tenants who were faced with eviction; supported the community in addressing environmental concerns and advocated on matters of social policy constantly and loudly. Being on the fringe gave us the ability to stand on principle. What were they going to do, cut our funding? Would we notice if they did?

We survived but today we no longer talk about health care reform but now we talk about primary care reform. Some may say that is just semantics but language is important. Our performance is no longer measured by our community but by clinical indicators that could easily be applied to any medical practice.

We are in the midst of a paradox. We have never been more successful but at the same time we have never been farther away from our purpose.
What would our founding fathers say. I suspect they would not be happy with our evolution away from our communities but unlike the words of Jefferson, the opinions of people like Joe Leonard should still resonate.

When we look at what is going on with Obama Care, it leads me to this obvious question. If Medicare was not created in Canada in 1963, would we create it today.

I do not believe if Medicare did not already exist we would create it in 2013 no matter what Charles Tupper may have said. It does not fit with our governments` current austerity agenda. It does not fit with our governments` current notions that public spending and raising taxes should never be done. And it certainly does not fit with how we have completed neglected the poor.

So we were just lucky that the Pearson government with the constant prodding of Tommy Douglas brought in Medicare when it did. If they had not had the willingness to enact it over the objections of the medical community, we might now be debating the merits of Harper Care.



Obamacare & Canad's Health care

IN the mid 1970',s working for the National Film Board as coordinator for a program called Challenge For Change I promoted a film, Citizens' Medicine,which advocated the idea of bringing medical services closer to citizens . A constant theme at meetings was people's fear of going to a doctor's office or a large intimidating hospital. The growth and sucess of CHCs are a testament to the vision of leaders during those years . The blowback to Obamacare in the USA and the lack of vision by politicians and healthcare leaders in Canada makes it hard to imaging how positive change to existing services can happen anytime soon.

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